Mueller Yolanda, Mpala Qhubekani, Kerschberger Bernhard, Rusch Barbara, Mchunu Gugu, Mazibuko Sikhathele, Bonnet Maryline
Epicentre, Paris, France Médecins Sans Frontières, Geneva, Switzerland National Tuberculosis Control Program Swaziland National Aids Program, Ministry of Health, Swaziland IRD UMI 233 TransVIHMI-UM-INSERM U1175, Montpellier, France.
Medicine (Baltimore). 2017 Sep;96(35):e7740. doi: 10.1097/MD.0000000000007740.
Although efficacy of 36 months isoniazid preventive therapy (IPT) among HIV-positive individuals has been proven in trial settings, outcome, tolerance, and adherence have rarely been evaluated in real-life settings.This is a prospective observational cohort study conducted in 2 primary care rural clinics in Swaziland.After negative tuberculosis symptom screening, patients either with the positive tuberculin skin test (TST) or after tuberculosis treatment were initiated on IPT for 144 weeks. In addition to routine clinic visits, adherence was assessed every semester.Of 288 eligible patients, 2 patients never started IPT (1 refusal, 1 contraindication), and 253 (87.8%), 234 (81.3%), and 228 (79.2%) were still on IPT after 48, 96, and 144 weeks, respectively (chiP = .01). Of 41 patients who interrupted IPT before 144 weeks, 21 defaulted (of which 17 also defaulted HIV care); 16 stopped because of adverse drug reactions; 2 were discontinued by clinicians' mistake and 1 because of TB symptoms. Five patients (1.7%) died of causes not related to IPT, 5 (1.7%) developed TB of which 2 were isoniazid-resistant, and 9 (3.1%) were transferred to another clinic. As an indicator of adherence, isoniazid could be detected in the urine during 86.3% (302/350) and 73.6% (248/337) of patient visits in the 2 clinics, respectively (chiP < .001).The routine implementation of IPT 36 months was feasible and good patient outcomes were achieved, with low TB incidence, good tolerance, and sustained adherence.
尽管在试验环境中已证明36个月的异烟肼预防性治疗（IPT）对HIV阳性个体有效，但在现实生活环境中，很少对其结果、耐受性和依从性进行评估。这是一项在斯威士兰的2家农村基层医疗诊所进行的前瞻性观察队列研究。在结核病症状筛查为阴性后，结核菌素皮肤试验（TST）呈阳性或接受过结核病治疗的患者开始接受144周的IPT治疗。除了常规门诊就诊外，每学期评估依从性。在288名符合条件的患者中，2名患者从未开始IPT治疗（1例拒绝，1例有禁忌症），分别有253名（87.8%）、234名（81.3%）和228名（79.2%）患者在48周、96周和144周后仍在接受IPT治疗（卡方检验P=0.01）。在144周前中断IPT治疗的41名患者中，21名患者失访（其中17名患者也中断了HIV治疗）；16名患者因药物不良反应停药；2名患者因临床医生失误停药，1名患者因结核病症状停药。5名患者（1.7%）死于与IPT无关的原因，5名患者（1.7%）患结核病，其中2名对异烟肼耐药，9名患者（3.1%）转至另一家诊所。作为依从性的指标，在两家诊所分别有86.3%（302/350）和73.6%（248/337）的患者就诊时尿液中可检测到异烟肼（卡方检验P<0.001）。36个月的IPT常规实施是可行的，并且取得了良好的患者治疗效果，结核病发病率低、耐受性好且依从性持续。
